Efficacy and safety of a calcium sensitizer, levosimendan, in patients with right heart failure due to pulmonary hypertension.

Abstract: Background: Despite using vasoactive and pulmonary hypertension (PH) specific therapies, the in‐hospital mortality of severe PH with right heart failure (RHF) is high. We conducted a prospective analysis evaluating the efficacy and safety of levosimendan in PH patients with severe acute RHF. Methods: Forty‐five PH patients hospitalized between January 2016 and November 2016 were recruited into a single arm, prospective, open‐label study. Levosimendan was administered at the rate of .05–0.1 μg/kg/min, up to a total dose of 12.5 mg. The primary endpoints were changes of World Health Organization Function Class (WHO‐FC) and Borg dyspnoea scores. Secondary endpoints included changes in 6‐min walk distance (6‐MWD), biochemical markers and right heart structure and function together with adverse events on day 7 and incidence of major cardiovascular events (death or readmission due to RHF) on day 30. Results: Forty‐five PH patients were enrolled. On the 7th day after levosimendan infusion, seven out of 13 PH patients with WHO‐FC IV improved by one class (<italic>P</italic> = .008). Borg dyspnoea scores, 6‐MWD and NT‐proBNP improved significantly (<italic>P</italic> < .001). Compared with baseline, the right atrial transverse dimension, end‐systolic eccentricity index and tricuspid annular plane systolic excursion improved significantly (58.8 ± 13.1 mm vs 53.7 ± 12.4 mm; 1.50 ± 0.27 vs 1.38 ± 0.23; 15.0 (13.0, 16.0) mm vs 15.8 (14.0, 17.4) mm, <italic>P</italic> < .005, respectively). One patient occurred sudden death after discharge during follow‐up. Conclusions: Intravenous levosimendan can effectively improve severe RHF of PH patients in hospital and well tolerated. [ABSTRACT FROM AUTHOR]